Midwives are misunderstood and underused in New Jersey, report says
If more births utilized the expertise of a midwife, and the profession as a whole were better understood and respected, New Jersey could see a significant improvement in the health outcomes of both mothers and babies, according to a report released on Tuesday.
The report from the Burke Foundation and the New Jersey Health Care Quality Institute cites evidence that the midwifery model of care could help reduce racial disparities and improve outcomes for individuals of color.
"Despite being one of the wealthiest states in the country, New Jersey ranks 47th in the country for maternal health, with racial disparities so severe that a Black woman in the state is seven times more likely to die of pregnancy-related complications than a white woman," said Atiya Weiss, executive director of the Burke Foundation. "In states that have greater access to midwifery care, there are better outcomes."
Fewer than 10% of New Jersey births in 2019 were attended by a midwife, the report found. The Garden State is currently home to a little more than 400 practicing midwives, according to the report — these are trained and credentialed clinicians who specialize in the perinatal period but can provide the full scope of healthcare.
"When we hear people taking about getting access to care and maternity care, we want you to know that if you go to a midwife and you see that person for your annual GYN check, that is going to be the same person who is going to carry you through the pregnancy, birth and postpartum period," said Linda Sloan Locke, who's been a certified nurse midwife in New Jersey for more than 40 years.
To create the report, Delivering Better Care: Midwifery Practice in New Jersey, the groups analyzed literature and interviewed experts and key stakeholders over the course of 2021 and 2022. In addition, they convened more than 40 individuals practicing midwifery.
"Midwives are an essential part of the health care workforce, yet their role is often misunderstood, underutilized, and undervalued," said Kate Shamszad, director of the Medicaid Policy Center at the New Jersey Health Care Quality Institute.
The proposed New Jersey budget includes a $1 million allocation for grants related to midwifery education and training. Advocates say this could help to improve the workforce pipeline; they're also interested in seeing a more diverse midwifery workforce, as white individuals make up about 90% of the workforce nationally.
In addition, the proposed budget includes a Medicaid funding increase of $15 million to raise reimbursement rates for maternity care.
Under Medicaid, which covers about 40% of births in the Garden State, midwives are reimbursed at 95% of the physician rate.
According to Julie Blumenfeld, president of the New Jersey affiliate for the American College of Nurse Midwives, upping the reimbursement rate to 100% would be key to expanding access to midwifery care in the state.
"Pay equity signals that midwives are valued contributors to shaping maternal health, it fosters a sense of collaboration between midwives and obstetricians/gynecologists, and it integrates midwives more fully into the maternal health system," Blumenfeld said.
Still, there is no Medicaid coverage for at-home births, and reimbursement for care at birth centers can be very limited, the report notes.